Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study.

Abstract

Despite greater toxicity, the use of MMC in a definitive CR regimen for anal cancer is justified, particularly in patients with large primary tumors. Salvage CR should be attempted in patients with residual disease following definitive CR before resorting to radical surgery.

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

“…A boost of 15 Gy (for complete responders), or 20 Gy (for partial responders), was given at 6 weeks using photons, electrons or an iridium 192 implant. This contrasts with the RTOG trial, which used a complex shrinking field technique to 45 Gy in 1.8 Gy fractions, with field sizes reduced at 30.6 and 36 Gy (Flam et al, 1996). If the primary tumour was still palpable after 45 Gy, a further 5.4 Gy was given in three fractions.…”

“…Furthermore, a Radiation Therapy and Oncology Group (RTOG) and Eastern Cooperative Oncology Group (ECOG) trial showed that MMC combined with 5-FU was superior to 5-FU alone when combined with radiation for colostomy-free survival (Flam et al, 1996).…”

“…Secondly, the clinical evidence suggests that a boost may not be necessary. The RTOG trial showed that only 8% of patients had residual disease requiring a boost following biopsy confirmation 6 weeks after CRT (Flam et al, 1996), while in the UKCCCR trial, the minority of patients (approximately 10%) who did not receive their boost as part of planned treatment, had an outcome similar to those who did receive a boost (Anonymous, 1996). Although regional failure is potentially a significant problem in anal cancer, 30 Gy appeared to be adequate for even macroscopic disease in the series of 45 patients from Nigro's group, suggesting high intrinsic sensitivity of this disease to the CRT combination (Nigro et al, 1983).…”

What is the role of radiation-chemotherapy in the radical non-surgical management of carcinoma of the oesophagus?

“…In the UKCCCR anal trial this combination proved the effective one. Interestingly, one study compared this combination with one dropping the mitomycin for anal carcinoma (Flam et al, 1996) and a difference was seen in local control. Mitomycin may be important in its radiosensitizing effect, perhaps because of its effect on hypoxic cells.…”

Anal canal carcinoma treatment results: the experience of a single institution

“…The use of chemotherapy in combination with radiotherapy was first evaluated in the early 1970s by a group at Wayne State University. Working on the observation that the use of fluoropyrimidine-based chemotherapy potentiates radiation, Nigro and colleagues used preoperative 5-fluorouracil (5-FU) (1000 mg/m 2 continuously on days 1-4 and 29-32) and mitomycin (10-15 mg/m 2 on day 1) in combination with moderate-dose (30 Gy) external beam radiation therapy (EBRT) 4. The first three patients treated with this regimen had no evidence of residual disease at the time of surgery, raising the question of whether combined chemoradiation therapy obviated the need for APR.…”